1164280848 NPI number — BEYOND SPEECH SOUTH SHORE

Table of content: DR. STEPHANIE CARIDAD LOO DDS (NPI 1811690829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164280848 NPI number — BEYOND SPEECH SOUTH SHORE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEYOND SPEECH SOUTH SHORE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164280848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 COUNTRY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCITUATE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02066-3709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-340-3106
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 COUNTRY WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCITUATE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02066-3744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-340-3106
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
508-340-3106

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)